- This epidemiologic analysis revealed that mortality rates are increasing in the middle-aged white male population, largely due to preventable conditions like poisonings and overdoses.
- Reductions in mortality were seen in other racial groups.
Mortality Rate Spikes for Middle-Aged Whites 11/3/15
Increases in poisoning, suicide, chronic liver disease impact rise in death rate
by Molly Walker
In a marked change from previous trends, increases in preventable death from alcohol and drug poisoning, suicide, and chronic liver disease, are associated with an increase in all-cause mortality rate for middle-aged white adults, according to detailed analyses of longitudinal mortality and morbidity data from the CDC.
From 1999 to 2013, the mortality rate for white non-Hispanic men and women rose by 34 per 100,000, with poisonings rising by 22 per 100,000, an increase in suicides of 9.5 per 100,000, and a 5.3 per 100,000 increase in chronic liver cirrhosis, Anne Case, PhD and Angus Deaton, FBA , both of Princeton University, reported in the Proceedings of the National Academy of Sciences.
Demographically, these increases seemed to be confined to white middle-aged adults. Mortality rates for black non-Hispanics fell by more than 200 per 100,000 and declined 60 per 100,000 among Hispanics. The gap between black and white mortality rates narrowed from 2.09 in 1999 to 1.40 in 2013.
Similar patterns were observed among specific causes of death. Poisoning deaths went from 10.2 per 100,000 higher for black non-Hispanic adults ages 45-54 in 1999 to 8.4 per 100,000 higher for white non-Hispanic adults by 2013. In 2013, mortality rates among white adults from cirrhosis and chronic liver diseases exceeded that of black non-Hispanics by 19 per 100,000.
In an email to MedPage Today, Marc Leavey, MD, a primary care specialist at Lutherville Personal Physicians in Lutherville, Md., called these results "a gut punch into reality" -- a reality which he observes on a regular basis.
"The staggering implication of the paper is that death rates are rising at alarming rates from diseases which are essentially preventable," said Leavey, who was not involved with the study. "There is more public outcry about diseases of much less frequency for which treatment, let alone cure, is far more difficult."
In fact, more white adults died from poisonings by 2013 than lung cancer, with suicide rates the next most common cause of death.
Education level also appeared to be a key driver of mortality rate increases, with substantial increases among white middle-aged adults with a high school degree or less. Mortality rates for this group increased by 134 per 100,000 from 1999 to 2013, while rates remained stable for those with some college education and actually fell by 57 per 100,000 for those with a Bachelor's degree or more.
Not surprisingly, poisoning deaths among white adults with lower education exhibited substantial increases, rising from 13.7 to 58.0. Mortality due to chronic liver disease and cirrhosis was up 50%.
Case and Deaton note that other demographic groups, including ages 30-34 and 60-64, have experienced increases in mortality due to poisoning, suicide, and chronic liver disease, but these increases only led to a rise in all-cause mortality for the midlife group.
Midlife morbidity also increased, with significant increases among white middle-aged adults reporting pain, psychological distress, and overall poor health. Reports of poor health unsurprisingly increased by 4.3%, while reports of excellent or very good health declined by 6.7%.
There was a 2.6% increase in reporting sciatica or chronic joint pain, with an additional 2.3% reporting neck pain and those reporting facial pain rose 1.3%. In addition, the portion of these adults with a score indicating serious mental illness on the Kessler six (K6) questionnaire rose from 3.9% to 4.8%. There was also a 2.4% increase in adults who reported difficulty in socializing, which is a risk factor for suicide.
Case and Deaton cite the increased availability of opioid prescriptions for pain, which began in the late 1990s, as potential reasons for increased mortality from poisoning and suicide. They comment that these adults may age into Medicare in worse health than the current elderly population.
Leavey said that if these results are substantiated, this should be "a clarion call to action" for clinicians, as well as society at large.
"This data needs to be front and center on tonight's news, occupy activists' demonstrations, infiltrate the psyche of the population to realize that those activities which are minimized in the physician's office are major impacts on people's health," he concluded.